What Are Common Reasons for Filing Dental Malpractice Cases?

You’ve been through dental school where you may have briefly learned about dental malpractice. You may have even heard of peers being named in claims. But have you ever really learned the most common reasons for the filing of dental malpractice cases?

According to the National Practitioner Data Bank, almost 6,600 dental malpractice payouts were made between 2018 and 2023, with 79 exceeding $1 million. This figure doesn’t account for the number of claims that were actually made against dental professionals — and successfully fought by their dental malpractice defense team.

Beyond financial costs, both malpractice claims and licensing board complaints can cause a ton of stress and put your professional reputation at risk. Board complaints could result in license suspension or revocation, even if you didn’t do anything wrong.

Recognizing common triggers for dental malpractice lawsuits helps protect the practice you’ve worked hard to build. In this piece, we examine the frequent reasons patients file dental malpractice claims, effective mitigation strategies, and how you can help protect your career and business.

5 Most Common Reasons for Filing Dental Malpractice Cases

An analysis published in the Journal of the California Dental Association (CDA) of dental malpractice data from the National Practitioner Data Bank reveals that from 1990 to 2018 more than 1,500 claims are filed annually, with settlements increasingly exceeding $100,000 in 2022. According to 2016-2020 claims data, the following five procedures represent the procedures with the highest average total incurred costs in dental malpractice claims.

1. Surgical extractions
2. Simple extractions
3. Implant surgery/placement
4. Root canal therapy
5. Crown procedures

More importantly, the CDA reports that a concerning trend has emerged across procedures: while dental malpractice claims under $100,000 have decreased over three decades, those exceeding $100,000 have steadily increased. Of the five procedure categories, four have seen payout increases of more than 20% between 2016 and 2020 alone. Let’s go through each of the claim-culprits in-depth:

1. Surgical extractions

Surgical extractions top the list at $193,871 in average total incurred costs per claim, a 29% increase from 2016. Common dental malpractice cases arise from:

• Damage to adjacent teeth
• Broken jaw in older patients
• Incomplete tooth removals that leave root fragments

Postoperative complications like severe bleeding, infection, or dry socket — especially when proper follow-up protocols aren’t established — generate significant claims. There’s also reports of sinus perforation during upper molar extractions and nerve damage during lower third molar removals. These often result from failure to identify anatomical variations on x-rays.

2. Simple extractions

Despite being “routine,” simple extractions generate average claims of $140,027, a 56% increase from 2016. Wrong tooth extractions represent the most costly sort of error. Other claims involve:

• Fracturing adjacent teeth
• Leaving root tips
• Damaging neighboring restorations

How does this happen? Sometimes it’s the dentist’s failure to review medical history that results in excessive bleeding in patients on anticoagulants or with bisphosphonate-related osteonecrosis.

Additional causes include inadequate anesthesia leading to the patient moving suddenly, aspirated or swallowed teeth, and the dentist’s failure to recognize when a simple extraction requires surgical intervention.

3. Implant surgery/placement

Implant procedures average $132,246 in claims. Primary complications include:

• Nerve damage
• Permanent numbness
• Sinus perforation during maxillary placement

Might not be too surprising, but poor bone assessment or inadequate site preparation can lead to implant failure. Infections can also arise from breaks in sterile technique or treating uncontrolled diabetics and smokers without proper screening. There are also aesthetic failures — placing implants at incorrect angles, depths, or positions. Dental malpractice claims also stem from placing implants too close to other teeth or implants, compromising both structures.

4. Root canal therapy

Root canal claims averaged $127,136, showing a 73% increase since 2016 — the greatest increase of any procedure type. Procedural errors include:

• Perforation of roots
• Separated instruments in canals
• Missed canals causing persistent infection

Many root canal claims involve teeth fracturing after treatment due to delayed crown placement. There are also sodium hypochlorite accidents caused by inadequate rubber dam isolation, which can lead to tissue necrosis, and thus… claims. And if dentists perform root canals on teeth with poor prognoses, and don’t get a signed informed consent statement that lists risky outcomes, it can generate both clinical failures and legal claims.

5. Crown procedures

Crown-related claims average $112,545, a 21% increase from 2016. Technical failures include:

• Over-reduction causing pulp exposure
• Under-reduction leading to crown fracture
• Poor margins creating recurrent decay

Common crown dental malpractice claims involve shade mismatches on front teeth where patients expect perfect results and inadequate crown retention or cement contamination. There are also claims alleging the failure to warn patients about potential complications and not addressing underlying periodontal disease before crown placement.

What Are Some Risk Mitigation Tips to Prevent Malpractice Claims?

While it’s impossible to eliminate malpractice claims, systematic risk management can significantly reduce exposure. The California Dental Association emphasizes that successful risk management requires commitment from the entire dental team, not just the dentist. The following five evidence-based approaches have proven effective in preventing malpractice claims.

Implement diagnostic protocols

The Journal of the American Dental Association found that diagnostic errors account for 8.7% of dental malpractice claims, with missed diagnoses comprising 78.6% of these errors. Some suggestions include:

• Conduct systematic oral cancer screenings at every appointment and verbally explain what you’re doing.
• Use a standardized checklist for comprehensive exams to ensure nothing is overlooked (per your state’s guidelines).

Document everything thoroughly

Thorough incident reports can be crucial for your defense if a claim arises. To do this:

• Maintain detailed records of diagnoses, treatment plans and patient conversations.
• Include reasons for clinical decisions, especially when determined appropriate or necessary to deviate from guidelines or protocols.
• Document discussions, including risks and patient questions.
• Record any complications immediately — along with corrective actions taken.

Obtain proper informed consent

Go beyond having patients sign informed consent forms and:

• Discuss specific risks relevant to their procedures, alternative treatments, and consequences of no treatment.
• Use visual aids or models when explaining complex procedures.
• Document that patients understood and had opportunities to ask questions.

Implement preprocedural verification

It’s always great to create tangible checklists for high-risk procedures. These can include:

• Verify the correct tooth with the patient before anesthesia.
• Take and review current radiographs immediately before treatment.
• Mark surgical sites when multiple teeth are involved.

Manage patient expectations

Be realistic about outcomes, especially for aesthetic procedures. This can look like:

• Show examples of actual results, not just ideal cases.
• Discuss limitations upfront and document these conversations.
• Address dissatisfaction immediately before it escalates to claims.

Protect Your Dental Practice With Malpractice Insurance From Berxi

With average malpractice settlements gradually increasing, dental malpractice insurance isn’t optional — it’s essential protection for your practice and personal assets. But you probably knew that. It’s having the right dental malpractice insurance for your team that matters even more.

Backed by Berkshire Hathaway Specialty Insurance Company with an A++ rating from AM Best, Berxi provides the financial stability you need during stressful claim situations.

In fact, our comprehensive dental malpractice coverage is designed specifically for today’s dental professionals. Our policies include critical features like consent-to-settle provisions, giving you a say in claim resolutions, and legal defense costs outside policy limits, ensuring your coverage isn’t depleted by attorneys’ fees. Plus, as a direct-to-consumer insurance provider, Berxi eliminates broker fees, potentially saving you on average up to 15% compared to traditional insurers.

Don’t wait until you’re facing a claim to discover you’re underinsured. Get your personalized quote in minutes and secure the protection your practice needs today.

 

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The views expressed in this article are those of the author and do not necessarily reflect those of Berxi™ or Berkshire Hathaway Specialty Insurance Company. This article (subject to change without notice) is for informational purposes only, and does not constitute professional advice. Click here to read our full disclaimer